[Two successful surgical cases of total left anomalous pulmonary venous connection with intact atrial septum--a report on their operative procedures and approaches]

Partial anomalous pulmonary venous connection (PAPVC) is often associated with other congenital heart diseases. Atrial septal defect, particularly, appears in about ninety percent of patients with PAPVC. Successful repairs were made in two patients of total left PAPVC with intact atrial septum. In one patient, left thoracotomy was made, and the vertical vein was anastomosed to the left atrial appendage. Cardiopulmonary bypass was not used in this case. In the other patient, median sternotomy was made, and the vertical vein was anastomosed to the posterior wall of the left atrium under cardiopulmonary bypass. Although postoperative prognosis are excellent sofar in both cases. We consider that the latter operative procedures are preferable for PAPVC not associated with atrial septal defect. In the present paper, the detailed operative procedures and approaches for these two cases are reported, and the concerning literatures are discussed.

Successful resection of descending thoracic aortic aneurysm using hypothermic total body retrograde perfusion without aortic clamp. Case report

A descending thoracic aortic aneurysm was safely resected via a median sternotomy, using total body retrograde perfusion without an aortic clamp. This new technique is an excellent adjunct in surgery for aneurysm of the proximal descending thoracic aorta.

Expression of blood group-related antigens in normal and malignant pancreatic tissue correlated with genotype of the patient defined by saliva glycoprotein

BACKGROUND

Seven murine monoclonal antibodies (MoAb) detecting blood group antigens of the Lewis system and their sialylated derivatives were used to define their immunohistochemical distribution in normal and malignant pancreatic tissues. The specific blood group antigens studied included Lewis(a) (Le(a)), Lewisb (Leb), Lewisx (Le(x)), Lewis(y) (Le(y)), sialyl-Lewis(a) (s-Le(a)), sialyl-lacto-N-tetraose (s-LNT), and sialyl-Lewisx (s-Le(x)).

METHODS

The expression of these antigens was analyzed by immunoperoxidase technique in pancreatic tissue of patients with (n = 27) and without (n = 19) pancreatic cancer. The genetic background of their secretor status and their Lewis phenotypes were determined by the enzyme-linked immunosorbent assay using purified salivary glycoprotein and MoAb against eight different blood group-related antigens (Le(a), Leb, Le(x), Le(y), H1, H2, A, B2), and the putative genotypes of the patients were classified as follows: SeLe, Sele, seLe, and sele.

RESULTS

The following results were obtained: (1) In normal pancreas, Le(a), s-Le(a), s-LNT, and s-Le(x) were expressed in ducts, but their expression was restricted to the luminal side of the cytoplasm (cytoplasmic type with positive polarity). Leb and Le(y) showed similar patterns of expression in ducts and some parts of the acinus. In contrast, Le(x) was absent in most cases. (2) Expression of Leb was observed in normal pancreatic ducts in all 46 patients, regardless of their genotypes. Le(a) and s-Le(a) were not expressed in specimens from patients with the seLe and sele saliva phenotypes. (3) In pancreatic cancer, the following antigens were expressed cytoplasmically in the proportion of cases indicated: Le(a) (78%), Leb (85%), Le(x) (33%), Le(y) (44%), s-Le(a) (78%), s-LNT (89%), and s-Le(x) (85%). They also were detected in the surrounding stroma. This pattern of expression is distinct from that found in normal pancreatic tissue. Patients with Sele and sele genotypes did not express Le(a) or s-Le(a), except in one case. (4) Serum levels of carbohydrate antigen 19-9 (CA 19-9) were not elevated in patients with pancreatic cancer with the Sele and sele genotypes but were elevated in most patients with SeLe and seLe genotypes.

CONCLUSION

The overall findings indicate that Lewis-related antigens act as pancreatic tissue-related antigens, depending in part on salivary phenotypes of the patient. With proper antigen selection and the determination of secretor status, these anti-blood group MoAb may be of clinical utility in the diagnosis of pancreatic cancer.

[A case report on the sliding commissuroplasty for mitral regurgitation due to posterior commissural chordal rupture]

We have performed a mitral valve reconstruction on a 31-year-old man who suffered from infective endocarditis four years ago. Severe mitral regurgitation and posterior commissural chordal rupture were noted. The mitral valve was repaired by Carpentier's sliding commissuroplasty and ring annuloplasty. The postoperative course was uneventful, and mitral regurgitation completely disappeared. It appears that Carpentier's sliding commissuroplasty is a superior new reconstructive technique for mitral regurgitation due to commissural chordal rupture.

High-resolution cardiac SPET study using fanbeam collimators in infants

High-resolution three-headed single photon emission computed tomography (SPET) equipped with fan-beam collimators was applied to myocardial perfusion imaging in infants aged from 1 to 11 months (n = 5). A tabletop designed specifically for infants was fixed on the SPET couch to reduce the radius of camera rotation to 13.2 cm. Significant improvement in resolution was achieved with the fan-beam collimators compared to parallel-hole high-resolution collimators. With the administration of approximately 37 MBq (26-44 MBq) 201Tl, 5 min acquisition time was possible for SPET imaging, which provided good image quality in all patients. Thus, a smaller administration dose is possible within a practical short acquisition time. High-resolution fan-beam SPET imaging can be a routine diagnostic method for heart disease in newborn babies and infants.

[Problems and prevention in using arterial grafts for coronary artery bypass grafting]

The arterial graft has proved to be superior to the saphenous vein graft for coronary bypass grafting (CABG), because of its excellent long-term patency. However, there mains controversial on the choice of the arterial grafts. Six hundreds and twenty seven patients who had CABG using both arterial grafts and saphenous vein grafts, operated upon over 11-years period between 1980 and 1991, have been analysed. Some disadvantages and complications associated with the use of arterial grafts were demonstrated in our series. We discussed, the flow capacity, myocardial protection and postoperative complications in using arterial grafts for CABG.

A simulation of dynamic SPECT using radiopharmaceuticals with rapid clearance

Data acquisition in SPECT assumes that there is no change in radionuclide distribution during data collection. However, this assumption is not valid in radiopharmaceuticals with rapid temporal changes in radioactivity. Artifacts and quantitative errors are studied using phantom studies, mathematical models, and clinical myocardial data. Projection data of each model were sequentially multiplied by weighting coefficients that varied mono-exponentially with time, and the SPECT images were reconstructed. A long data acquisition time in comparison to the clearance of the tracer can be a significant cause of artifact. When the myocardial septum-to-lateral count ratio is used as an index of distortion, a shorter acquisition time than the effective half-life of the tracer is required to reduce the error of the septum-to-lateral count ratio to within 10%. Since 180 degrees rotation acquisition causes artifacts depending on the direction of rotation, 360 degrees acquisition is preferable. Continuous repetitive rotation acquisition is a suitable method for dynamic SPECT to reduce quantitative errors and artifacts.

Serial change of iodine-123 metaiodobenzylguanidine (MIBG) myocardial concentration in patients with dilated cardiomyopathy

Serial change of the metaiodobenzylguanidine iodine-123 (123I-MIBG) myocardial concentration was investigated in patients with dilated cardiomyopathy (DCM). Eight DCM patients and 6 control subjects were examined. After the injection of thallium-201 and 123I-MIBG, planar chest images were obtained simultaneously for both tracers in every 30-60 min over 5 h. Serial changes of myocardial uptake ratio (MUR) were compared for both tracers. In DCM, the initial MUR of 123I-MIBG did not differ significantly from that of the controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in DCM. In particular, the decrease in the early phase (15-45 min) was significantly larger in DCM than in the controls (21.2% +/- 7.5% vs. 5.3% +/- 4.0%, P less than 0.01), showing a significant negative correlation with the left ventricular ejection fraction (r = -0.72 P less than 0.05). For 201Tl, neither the initial MUR nor the washout rate different significantly between the two. Thus, an early rapid decrease of the 123I-MIBG myocardial concentration might characterize DCM and reflect the severity of this disease.

T-cell-dependent production of IgG by human cord blood B cells in reconstituted SCID mice

Reconstitution of severe combined immunodeficient (SCID) mice with human lymphocytes has recently allowed the elucidation of abnormalities of immune responses in various immunological disorders. In the present study, mononuclear cells (MNC) from neonatal cord blood and adult peripheral blood were intraperitoneally injected into SCID mice to examine induction of human Ig in respective mice recipients. Human IgG was consistently detected in the serum of SCID transferred with adult MNC, but only a few SCID recipients of cord blood MNC showed detectable but low levels of IgG in the serum. The combination experiments of isolated B and T cells disclosed that some interactions between B and T cells might be necessary for IgG production in transferred SCID mice. Notably, transfer of cord blood B cells with adult but not cord blood T cells resulted in efficient induction of IgG, associated with a change in subclass distribution. The results suggest that inability of neonatal B cells to produce IgG can be overcome by transfer with adult mature T cells into SCID mice.

A new approach to chemoembolization for unresectable hepatocellular carcinoma using aclarubicin microspheres in combination with cisplatin suspended in iodized oil

Sixty-six consecutive patients with unresectable hepatocellular carcinoma (HCC) were treated with transcatheter arterial chemoembolization (TACE) using aclarubicin microspheres (ACRms) in combination with cisplatin suspended in iodized oil (Lipiodol, Laboratoire Guerbert, Paris, France) (CSL). The stages of the disease were as follows: Stage I (n = 1), Stage II (n = 10), Stage III (n = 26), and Stage IV (n = 29). The effectiveness of TACE was assessed by comparing ACRms with CSL with ACRms without CSL. Of 66 patients treated with ACRms and CSL, 62 (93.9%) could be examined for response. According to response criteria, there were 31 (50.0%) partial responses and 17 (27.4%) minor responses. In 13 cases (21.0%) there was no change and in 1 case (1.6%) there was progressive disease. The cumulative survival rate was 80.7% at 1 year, 64.2% at 2 years, and 50.6% at 3 years. The rates were significantly higher than those of the group treated with ACRms. Eleven patients in the ACRms and CSL group experienced clinical complications: cholecystitis (4.5%), pancreatitis (3.0%), liver abscess (3.0%), hepatic failure (3.0%), gastrointestinal bleeding (1.5%), and renal failure (1.5%). No lethal side effects related to the therapy were observed. TACE using ACRms in combination with CSL prolongs the survival of patients with unresectable HCC.

[Carbohydrate antigens as a tumor-associated antigen and prognostic indicators in carcinomas of the breast, esophagus, stomach, colorectum, and pancreas]

The immunohistochemical analysis using the monoclonal antibodies to the carbohydrate antigens were performed and suggested that CA19-9 is a tumor-associated antigen in gastric cancer, Leb, Ley, CA19-9, CSLEX1, SLX in colorectal cancer and pancreatic cancer, and Lex, Ley, and CSLEX1 in breast and esophageal cancers, respectively. Expression of the type 2 carbohydrate antigens had relation to the prognosis of patients with breast cancer. In colorectal cancer, the patients with high degree of expression of CA19-9 had a poor prognosis, and high risk of distant metastasis. Higher intensity of staining was observed in hepatic in comparison with primary lesion. Thus carbohydrate antigens showed important role as tumor-associated antigens and good indicator for evaluation of prognosis.

Structure of benzyloxycarbonyl-L-isoleucyl-L-alanyl-alpha- aminoisobutyryl-alpha-aminoisobutyrate methyl ester, Z-L-Ile-L-Ala-Aib-Aib-OMe

C26H40N4O7, Mr = 520.6, tetragonal, P4(3)2(1)2, a = 10.433 (1), c = 54.476 (7) A, V = 5930 (1) A3, Z = 8, Dm = 1.155 (3), Dx = 1.166 Mg m-3, lambda (Cu K alpha) = 1.54178 A, mu = 0.665 mm-1, F(000) = 2240, T = 295 K, R = 0.057 for 2037 observed reflections. The tetrapeptide adopts a type II beta-turn conformation with an extremely weak 4----1 intramolecular hydrogen bond [3.479 (7) A]. The molecules are held together in the crystal by three kinds of N-H---O intermolecular hydrogen bonds.

[A treatment of intractable sternal osteomyelitis--significant use of pedicle muscular flaps]

In recent years, the greater omentum of pedicle muscular flap has been used to treat chest wall infection and Sternal Osteomyelitis following cardiac or respiratory surgery. In Japan, however, there has been an increasing number of cases in which neither the greater omentum Nor the rectus muscle can be used due to the comparatively young age of the patient. There are also many cases undergoing abdominal surgery for malignant tumor and bypass surgery of the coronary artery in which the internal thoracic artery (ITA) and gastroepiploic artery (GEA) are used. We studied three such cases; a case of coronary aortic bypass graft (CABG) where ITA from both the right and left sides were used following stomach resection; a case in which CABG and gallbladder resection were carried out simultaneously; and a case of sternal osteomyelitis is years following surgery for ventricular septal defect. All three cases had undergone reconstructive surgery using the pectoralis major muscle or a pedicle muscular flap from the latissimus dorsi muscle. It is estimated that cases of CABG using both the right and left sides of ITA and GEA, cases of the elderly as well as cases of children will continue to increase. Consequently, cases of sternal osteomyelitis in which neither the omentum nor rectus muscle can be used will also increase. Therefore, it is considered that treatment using pedicle muscular flaps from the breast or dorsal area may be very effective. Herein, we report on the choice of treatment and its results.

Dynamic acquisition with a three-headed SPECT system: application to technetium 99m-SQ30217 myocardial imaging

A method for SPECT data acquisition, "continuous repetitive rotation acquisition," was developed with a high-sensitivity three-headed SPECT system. The method was applied to the dynamic imaging of 99mTc-SQ30217, a new myocardial imaging agent. After acquisition and reconstruction of SPECT data every minute, projection images at arbitrary intervals were used for tomographic reconstruction to determine the best timing of SPECT imaging in 99mTc-SQ30217. Based on a comparison of several possible acquisition intervals, SPECT data acquisition within 9 min after injection is recommended because of high myocardial uptake (myocardium-to-lung ratio, 2.83 +/- 0.42 (mean +/- s.e.m.) at 3-6 min) and relatively low hepatic uptake (myocardium-to-liver ratio, 0.85 +/- 0.13 at 3-6 min). The rate constant of the clearance of 99mTc-SQ30217 from the myocardium obtained by SPECT was: k1 = 0.249 +/- 0.050 per min (average half-life = 2.8 min) and k2 = 0.012 +/- 0.004/min (average half-life = 58 min). The continuous repetitive rotation acquisition SPECT study appears useful for imaging SQ30217 with its rapidly changing myocardial distribution.

Serum concentration and immunohistochemical localization of SPan-1 antigen in pancreatic cancer. A comparison with CA19-9 antigen

We studied SPan-1 antigen in 64 patients with pancreatic cancer by measuring serum concentrations with RIABEAD and examining the intratumor staining patterns immunohistochemically. Serum concentrations were elevated (greater than 30 U/ml) in 46 patients (72.0%), roughly the same percentage as with elevated serum CA19-9 concentrations. Ten out of 19 patients without CA19-9 antigen expressed SPan-1, and the combined rate of positivity was 86% (55/64). Immunohistochemically, CA19-9 was localized to the apical surface and the supranuclear cytoplasm of normal epithelial cells, but SPan-1 was localized to the supranuclear cytoplasm or throughout the cytoplasm. After malignant degeneration, both antigens were found over the entire plasma membrane, throughout the cytoplasm (loss of polar distribution) and in the stroma surrounding the cells. SPan-1 was detected in 48 out of 54 adeno-carcinomas of the pancreas (89%), and all cases with an elevated serum concentration displayed stromal staining in the cancer tissues. The utility of SPan-1 antigen as a tumor marker for diagnosing pancreatic cancer was found to be equal to that of CA19-9.

[Myocardial perfusion imaging with 99mTc-SQ30217: application of three-headed SPECT system]

The early dynamic change of a new myocardial imaging agent, 99mTc-SQ30217, was investigated in SPECT study. A three-headed high sensitivity SPECT system was employed to evaluate the serial changes of accumulation pattern in the heart, lung and liver using a "continuous repetitive acquisition" mode. The myocardial activity reached a peak rapidly and decreased with rapid clearance rate. The analysis of myocardial clearance curve showed a T1/2 of 2.8 minutes (k1 = 0.25 +/- 0.12/min) in the rapid phase, and a T1/2 of 57 minutes (k2 = 0.012 +/- 0.011/min) in the slow phase. The tracer clearance in the lung was more rapid, while the hepatic uptake reached a peak approximately 10 to 15 minutes after injection. When the serial SPECT images were reviewed, the early 3-minute acquisition within 10 minutes after injection showed better image quality than the images obtained after 10 minutes. The hepatic activity did not obscure the infero-septal wall in the earlier images, but did in the images 10 minutes after injection. Thus, quick SPECT data acquisition seemed to be desirable for this agent. We concluded that 99mTc-SQ30217 was a promising radiopharmaceutical for myocardial perfusion imaging.

A practical method for position-dependent Compton-scatter correction in single photon emission CT

A new method is proposed to subtract the count of scattered photons from that acquired with a photopeak window at each pixel in each planar image of single-photon emission computed tomography (SPECT). The subtraction is carried out using two sets of data: one set is acquired with a main window centered at photopeak energy and the other is acquired with two subwindows on both sides of the main window. The scattered photons included in the main window are estimated from the counts acquired with the subwindows and then they are subtracted from the count acquired with the main windows. Since the subtraction is performed at each pixel in each planar image, the proposed method has the potential to be more precise than conventional methods. For three different activity distributions in cylinder phantoms, simulation tests gave good agreement between the activity distributions reconstructed from unscattered photons and those from the corrected data.

[Coronary-coronary bypass (C-C bypass) in 2 cases]

A left IMA graft to LAD associated with c-c graftings using saphenous vein were simultaneously performed in 70-year old man and 44-year-old man with multiple coronary disease. Postoperative catheterization showed patency in both cases. It is advisable to perform c-c bypass for patients with calcification of ascending aorta or stenosis of distal RCA such as 4-PD or 4-AV.

Reversal of methotrexate cytotoxicity to human bone marrow cells and leukemic K562 cells by leucovorin: methotrexate polyglutamates formation as a possible important factor

Methotrexate (MTX) is metabolized intracellularly to MTX-polyglutamates (MTX-PGs), which markedly inhibit several folate-dependent enzymes. Polyglutamation defect, therefore, is one of the important factors in drug resistance. In this study, reversal of MTX cytotoxicity by l-leucovorin (l-LV) was investigated using normal human bone marrow granulocyte progenitor cells (G-CFCs), and MTX-sensitive and -resistant leukemic K562 cell lines; the latter showed diminished polyglutamation. Cytotoxicity of 10(-7)M MTX to G-CFCs was completely reversed by an equimolar concentration of l-LV, but with higher MTX concentrations, relatively more l-LV was required. The reversal of MTX cytotoxicity by l-LV was more effective against bone marrow cells than MTX-sensitive K562 cells; this reversal seemed to be correlated to the total intracellular MTX levels as well as MTX-PG formation (low in bone marrow cells and high in K562 cells). When MTX-sensitive and -resistant K562 cells were incubated with MTX under conditions in which the total intracellular MTX levels of both cells were similar, successful reversal of MTX toxicity by l-LV was demonstrated in MTX-resistant cells, but not in MTX-sensitive cells, suggesting that an increase of MTX-PG formation in MTX-sensitive cells may explain the failure of l-LV to overcome MTX cytotoxicity. In addition to competitive reversal of MTX cytotoxicity by LV, noncompetitive reversal relating to variable formation of MTX-PGs is suggested to be another important factor in the mechanism of the reversal of MTX cytotoxicity by LV.

[A case of tracheoesophageal fistula in Behçet's disease repaired with pericardial patch and gastric roll]

A 23-year-old man suffering from Behçet's disease developed a tracheoesophageal fistula. Subtotal esophagus was stripped and replaced with a gastric tube along greater curvature. The defect of membranous portion of the trachea (2 X 1 cm) was closed with a pedicled pericardial patch and covered with omentum. Transient postoperative recurrent nerve palsy was recovered in about 2 months. He is going well without any significant complaints. He received steroid hormone administration and platelets transfusion because of complicated ITP (Idiopathic Thrombocytopenic Purpura).

Inorganic chemical approaches to pharmacognosy. VII. X-ray fluorescence spectrometric studies on the inorganic constituents of crude drugs. (5). The relationship between inorganic constituents of plants and the soils on which they are grown

Inorganic constituents of the leaves of several kinds of plants growing on different soil types were investigated using energy-dispersive X-ray fluorescence spectrometry. The results can be summarized as follows: (1) Each plant exhibited a characteristic metals profile, even if they were grown on similar soil types. (2) As we would expect, the metals profile of the plant leaves depends on the inorganic constitution of the soil on which it is grown. However, the degree of the influence of the soil types on the metals profile of the plant differs according to the kind of inorganic element: Ca and Cu are almost independent of the soil types, but the Ti and Fe content is dependent upon the soil types. (3) Sr content of plant leaves is closely related to the ratio of Sr to Ca of the soil on which the plants are grown. (4) This information should be helpful in identifying the producing district or original plant of a crude drug by its metals profile.

Study of 16,16-dimethyl prostaglandin E2 for prevention of stress ulcer after hepatectomy of experimental cirrhotic liver and its influence on hepatic regeneration

The influence of 16,16-dimethyl prostaglandin E2 (16,16-dm PGE2; an agent used for the prevention of stress ulcer after hepatectomy of the cirrhotic liver) on liver regeneration after hepatectomy was studied in rats. The following results were obtained. Ulceration after the stress of 6 h of water immersion was markedly suppressed in rats treated with 30 r/kg of 16,16-dmPGE2 as compared with the untreated controls. In animals that received hepatectomy alone, the gastric pH and gastric mucosal blood flow showed significant reduction from the preoperative levels. In animals that received hepatectomy plus 16,16-dmPGE2 treatment the postoperative reduction in the gastric pH and gastric mucosal blood flow was suppressed, suggesting the effectiveness of 16,16-dmPGE2 treatment in the prevention of stress ulcer after hepatectomy of the cirrhotic liver. The 3H-thymidine uptake percentage and thymidine activity 24 h after hepatectomy and the DNA content 30 h after hepatectomy were significantly higher in animals treated with 16,16-dmPGE2 than in the untreated controls. In animals that were treated intraperitoneally with 50 mg/kg of indomethacin 6 h before hepatectomy the mitotic index 30 h after hepatectomy was markedly lower than that in untreated controls. This indomethacin-induced reduction in the mitotic index tended to be normalized by treatment with 16,16-dmPGE2. These results suggest that 16,16-dmPGE2 treatment effectively prevents stress ulcer and favorably affects hepatic regeneration after hepatectomy of the cirrhotic liver.

[Serial change of 123I-metaiodobenzylguanidine (MIBG) myocardial concentration in patients with dilated cardiomyopathy]

123I-Metaiodobenzylguanidine (MIBG) is expected to be useful agent for functional evaluation of the myocardial sympathetic innervation. The aim of this paper is to investigate serial change of 123I-MIBG myocardial concentration in patients (pts) with dilated cardiomyopathy (DCM) as compared with 201Tl uptake. Eight pts with DCM and six non-cardiac subjects (controls) were examined. After injection of 111 MBq (3mCi) 201Tl and 111 MBq (3 mCi) 123I-MIBG, simultaneous myocardial imaging in anterior view was performed for both tracers in every 30-60 minutes during 5 hours (6 images). Myocardial uptake ratio per pixel to the injected dose was calculated for each tracer with background and cross-talk correction on each image. In pts with DCM, myocardial uptake ratio of 123I-MIBG did not differ significantly from that of controls. The washout of 123I-MIBG from the myocardium, however, was significantly increased in pts with DCM as compared with controls. The % decrease of the radioactivity in 3 hours was 46.9 +/- 13.8% in DCM, whereas 18.0 +/- 7.7% in controls (p less than 0.05). Especially, the decrease in the early phase (less than 1 hour) was significantly larger in DCM than controls (21.2 +/- 7.5% vs 5.3 +/- 4.0%, p less than 0.01). For 201Tl, on the other hand, neither uptake ratio nor washout rate, differed significantly between the two. In conclusion, the rapid washout of 123I-MIBG in the early phase may reflect some sympathetic dysfunction in pts with DCM.

[Effects of dopamine on stress ulcer]

Preventive effect of dopamine on stress ulcer formation was investigated in rats. Dopamine 1-10 micrograms/kg/min suppressed the elevation of ulcer index significantly after water immersion and restraint stress in a dose-dependent fashion, however ulcer indices of 25 micrograms/kg/min of dopamine were higher than 10 micrograms/kg/min. Dopamine 1-10 micrograms/kg/min suppressed the decrease of gastric mucosal blood flow, gastric mucosal prostaglandin E2 content and gastric transmucosal potential difference during stress loading in a dose-dependent manner, although the suppression of them in 25 micrograms/kg/min of dopamine was smaller than in 10 micrograms/kg/min also. Dopamine suppressed the increase of gastric acid secretion and gastric motility during stress loading in a dose-dependent fashion up to 25 micrograms/kg/min. These results indicates that dopamine suppresses the formation of stress ulcer by increasing defensive factors and decreasing aggressive factors.

Structure Elucidation of Inflexarabdonins G and H: Two New Diterpenoids from Rabdosia inflexa

From the dried aerial parts of RABDOSIA INFLEXA, two new diterpenoids, named inflexarabdonin G and inflexarabdonin H were isolated and the structures were elucidated as ENT-1beta,3alpha,11alpha-trihydroxy-kaur-16-en-15-one 3,11-diacetate and ENT-1beta,3alpha,11alpha-trihydroxy-kaur-16-ene-6,15-dione 1,3-diacetate, respectively, on the basis of spectroscopic and chemical evidence.

Antagonistic effects of interleukin 6 and G-CSF in the later stage of human granulopoiesis in vitro

The effect of recombinant human interleukin 6 (rhIL-6) on the in vitro growth of human bone marrow myeloid progenitors (granulocyte-macrophage colony-forming units, CFU-GM) was investigated. Recombinant human IL-6 by itself did not induce colony formation. When rhIL-6 at various concentrations was added to the CFU-GM colony cultures containing recombinant human granulocyte colony-stimulating factor (rhG-CSF) or recombinant human granulocyte-monocyte/macrophage colony-stimulating factor (rhGM-CSF), rhIL-6 significantly suppressed the colony formation induced by rhG-CSF, but not by rhGM-CSF. This suppressive effect of rhIL-6 on rhG-CSF-induced, but not rhGM-CSF-induced colony formation was confirmed by using an MY10(+)-cell-enriched population. Neither interleukin 3 nor interleukin 1 alpha suppressed the growth of myeloid progenitors. The preincubation of bone marrow cells with rhIL-6 for a short time (30 min) resulted in a reduction of colonies induced by rhG-CSF, but not by rhGM-CSF. The suppressive effect of rhIL-6 on rhG-CSF-induced colony formation was not observed when the cells were preincubated together with rhG-CSF at a high ratio of rhG-CSF to rhIL-6. The rhIL-6-mediated suppressive effect was further confirmed by blocking the effect by the anti-IL-6 antibody. These results suggest antagonistic interaction between IL-6 and G-CSF in the later differentiation of myeloid progenitors.

[Estimation of scatter component in SPECT planar image using a Monte Carlo method]

A Monte Carlo simulation was performed to estimate quantitatively the scattered photons in planar images of SPECT. As a phantom we used a water-filled cylinder with a line source and calculated the energy spectra of primary and multiple scattered photons separately at each pixel of the planar images. The energy spectra of primary and scattered photons were studied on following parameters: the size of the phantom; the location of the source; the width of the energy window centered at 72.3 (Tl-201), 141 (Tc-99m), and 159 keV (I-123); and the view angle of the planar images. Obtained results were; (1) the energy spectra of Compton scattered photon varied with the phantom size, the source location, and the photopeak energy, (2) the scattered photons within energy windows of 10-30% centered at the photopeak energy were mainly composed by Compton scatter of the first order, (3) the higher order scattering component of the Compton photons did not represent the location of the line source on the planar image, and (4) the scatter fraction defined by the ratio of the scattered photons to the primary photons increased with increasing the size of the phantom and the width of energy window at the low photopeak energy. From the results, we discussed on the scatter subtraction methods.

[A three-headed SPECT system with high resolution and high sensitivity: application to myocardial imaging]

A three-headed single-photon emission computed tomography (SPECT) system was developed, and the fundamental SPECT performance and clinical applications were investigated. The full width at half maximum (FWHM) of the SPECT system is 10.8 mm at the center of rotation with a radius of 20 cm. In clinical applications, 201Tl myocardial images with the three-headed system demonstrated a distincter and thinner myocardium compared to those with the dual-headed system. The right ventricular wall was observed even in patients without right ventricular overload. Owing to both the increased sensitivity and resolution, the three-headed system has high performance capability in clinical use such as ECG-gating and dynamic studies.

Structure of benzyloxycarbonyl-L-alanyl-alpha-aminoisobutyl-alpha-aminoisobutylic acid

The x-ray diffraction study of the C-terminally unprotected tripeptide benzyloxy-carbonyl-L-alanyl-alpha-aminoisobutyl-alpha- aminoisobutylic acid (Z-L-Ala-Aib-Aib-OH) has shown that the molecule adopts a consecutive type III beta-turn, which characterizes a right-handed 3(10) helix. A very weak 4----1 intramolecular hydrogen bond with the long N...O distance of 3.32 A, and a unique "oxy analogue" of the 4----1 hydrogen bond wih the O...O distance of 2.77 A, were observed. The stability of the observed conformation with the asymmetric Aib residues was theoretically evaluated by a conformation-energy calculation. The stereochemical characteristics of Aib and Ala residues were made clear by a comparison of the conformations of the short peptides containing both Aib and Ala residues.

Diuretic effects of L-threo-3,4-dihydroxyphenylserine (L-threo-DOPS) in anesthetized rats

A synthetic amino acid, L-threo-3,4-dihydroxyphenylserine (L-threo-DOPS), can be converted to (-)-norepinephrine (NE) by aromatic L-amino acid decarboxylase (AADC) in various mammalian tissues. Recent studies have indicated the pressor and diuretic effects of L-threo-DOPS. In this study, we examined the effects of L-threo-DOPS on renal hemodynamics and function in anesthetized rats, and evaluated possible mechanisms of the diuresis. Intravenous infusion of L-threo-DOPS at 120 micrograms/kg/min exerted a significant increase in mean arterial pressure (MAP). There was a slight but nonsignificant decrease in renal blood flow (RBF). Although the glomerular filtration rate (GFR) remained at a constant level, urine flow (UF) and urinary sodium excretion (UNaV) increased significantly during the drug infusion. Pretreatment with AADC inhibitor, benserazide, completely blocked both the pressor and diuretic effects of L-threo-DOPS. When the renal perfusion pressure was protected from the pressor effect of the drug by using a Blalock clamp, the drug-induced diuresis was abolished. The diuretic effect of L-threo-DOPS was markedly attenuated by the administration of phentolamine. There was a positive correlation between plasma NE concentration and UF during the infusion of L-threo-DOPS. Intrarenal arterial infusion of L-threo-DOPS at 20 micrograms/kg/min was without effect on renal function. These results indicate that diuresis and natriuresis induced by L-threo-DOPS are dependent on the pressor effect of NE via peripheral alpha-adrenoceptor activation.

Coronary artery bypass in a 15-year-old girl with pseudoxanthoma elasticum

A 15-year-old girl with pseudoxanthoma elasticum and associated severe coronary artery disease underwent double coronary artery bypass using left internal mammary artery and saphenous vein. Preoperatively the patient had life-threatening syncope and positive treadmill test results. The postoperative course was uneventful, and the patient has been doing well for 3 years. Pseudoxanthoma elasticum is a rare disease that can cause premature coronary arterial obstructive disease in children and adolescents.

[A study of bleeding peptic ulcer in the elderly in the view of risk factors]

We treated 448 patients for peptic ulcer from 1970 to 1988. Among them, 52 cases were bleeding peptic ulcer in the elderly. 32 cases (61.6%) had a duration of illness of less than 3 months, and the most common symptom was abdominal pain (51.9%). 22 cases (44.0%) were in shock and 32 cases (62.7%) had accessory diseases. Twelve cases were treated medically, while 40 cases were treated surgically. Elective operations were performed in 15 cases, and their mortality was 6.7%. Emergent operations were performed in 25 cases, and their mortality was 28.0%. The mortality of of cases involving both shock and accessory diseases was 57.1%, and of this group, all 3 cases treated medically died. When bleeding exceeded 2000cc was the mortality 46.7%. Regarding cases of emergent operation involving shock or accessory diseases, the mortality was 18.2% in the cases treated medically for less than 4 days and had the episodes of massive bleeding less than 3 times, but 62.5% in other cases. The results of this study suggest that aggressive surgical treatment in an early stage may reduce the mortality in elderly patients with peptic ulcer.

[The effect of cimetidine to suppress the reduction of gastric mucosal blood flow caused by immobilization in water--its relationship to noradrenaline]

Reduction of gastric mucosal blood flow has been regarded as being the most important event for the gastric defensive mechanisms. In male Wistar rats immobilized in water, the authors recently studied the effect of cimetidine on the gastric mucosal blood flow and the mechanism for that action of cimetidine. In vivo, animals were divided into four groups (PGE2-treated, PGI2-treated and cimetidine-treated groups and an untreated control group), and mucosal blood flow before and 4 hours after the start of immobilization was determined with the electrolytic hydrogen gas clearance technique. In vitro involving perfusion of the isolated gastric blood vessels, the effect of treatment with PGE2, PGI1 or cimetidine in the presence of stimulation with noradrenaline was assessed. The stress-caused blood flow reduction was significantly suppressed in the PGE2-treated group (26.9% reduction in blood flow), the PGI2-treated group (15.7%) and also in the cimetidine-treated group (39.2%) as compared to the controls in which blood flow was reduced by 58.0% following immobilization. In vitro, cimetidine treatment resulted in a reduction of gastric perfusion pressure by 36.6% at maximum although the reduction was more marked following treatment with PGE2 (44.9% reduction) or PGI2 (49.4%). This result suggests that cimetidine also has a vasodilative action.

Improvement of the rapid immunoperoxidase staining method for intraoperative pathological diagnosis of pancreatic cancer using microwave irradiation

The rapid immunostaining of gastrointestinal cancer-associated antigens, CA19-9, CEA, DUPAN2, and CA50, for intraoperative pathological diagnosis of pancreatic cancer can be completed in only 13 min by applying microwave irradiation, which was used to accelerate the incubation of the primary antibody. Only 3 s irradiation at 500 W for fresh-frozen sections produced specific antigen staining of greater intensity than that obtained with longer incubation, and tissue preservation was satisfactory with minimal non-specific background staining. This rapid immunoperoxidase staining method on the cryostat section of pancreatic biopsy specimens can provide important information for determining an appropriate operative method for pancreatic cancer patients.

Transcatheter arterial chemoembolization therapy for hepatocellular carcinoma using polylactic acid microspheres containing aclarubicin hydrochloride

Transcatheter arterial chemoembolization therapy using polylactic acid microspheres containing aclarubicin hydrochloride (ACR) was performed in 62 patients with primary hepatocellular carcinoma. These microspheres were about 200 microns in diameter and contained 10% (w/w) aclarubicin. A single dose of polylactic acid microspheres containing ACR (50-100 mg of ACR) was administered 1 to 8 times with a mean of 2.2 doses (a total of 160 treatments) in 62 patients. Antitumor effects were observed from the decrease in serum alpha-fetoprotein levels (82.1% of the patients) and in two dimensional size of tumor on computed tomography (93.6%). The cumulative survival rate was 54.3% at 1 year, 24.6% at 2 years, and 19.2% at 3 years, respectively, among 59 patients with unresectable tumors. In 3 resected liver specimens, there was a significant accumulation of ACR in the tumor, and severe necroses of the tumors were observed histologically. Systemic toxicity was mild and all patients tolerated this treatment. These results suggest that transcatheter arterial chemoembolization with the use of polylactic acid microspheres containing ACR is a useful tumor-targeting chemotherapy and is effective in the treatment of hepatocellular carcinoma.

[Study of complications after endoscopic sclerotherapy for esophageal varices--particularly 2 cases that changed portal circulation after sclerotherapy]

In 116 patients with esophageal varix due to liver cirrhosis who received the endoscopic sclerotherapy, the following complications were observed after the sclerotherapy: 38 ulcer formation; 19 chest pain; 16 hypotension; 15 fever; 12 pleural effusion; 6 esophageal stenosis and so on. Furthermore, two cases with marked changes of portal circulation were experienced after the sclerotherapy. The first case had severe bleeding out of duodenal varix four months after the sclerotherapy and died because of massive bleeding. The second case had hepatic encephalopathy six months after the sclerotherapy. In both cases, angiography revealed the development of collateral veins after the sclerotherapy. Because the abrupt intercept of the esophageal varix by the successful sclerotherapy causes the increase of the other collateral blood flow, the changes of portal circulation must be watched carefully afterward.

Inhibitory effect of nisoldipine on angiotensin-II-induced renal actions in anesthetized dogs

Renal effects of nisoldipine, a potent calcium channel blocker, were examined in anesthetized dogs. Intrarenal arterial infusion of nisoldipine (2, 10, and 50 ng/kg per min) had no effect on mean systemic blood pressure and heart rate and there was no significant change in renal hemodynamics during infusion of various doses of the drug. Urine flow and urinary excretions of sodium, chloride, and potassium were increased by nisoldipine in a dose-related manner. Fractional excretions of sodium and chloride were markedly elevated with the highest dose given thereby indicating that tubular reabsorptions of sodium and chloride were inhibited by nisoldipine. Nisoldipine (50 ng/kg per min) abolished the decreasing effects of angiotensin-II on glomerular filtration rate, urine flow, and urinary excretion of electrolytes but not the decrease in renal blood flow by the peptide. Angiotensin-II-induced reduction of fractional excretion of electrolytes was completely blocked by nisoldipine. Renal responses to norepinephrine were unaffected by nisoldipine. Thus, nisoldipine administered intrarenally to anesthetized dogs exerts a diuretic action by way of tubular effects, as is the case with other dihydropyridine calcium channel blockers. Nisoldipine seems to effectively antagonize the renal response to angiotensin-II. Thus, the preferential inhibition of angiotensin-II-induced antidiuresis may mean that nisoldipine interferes with stimulatory effects of angiotensin-II on the renal tubular reabsorption of electrolytes and water.

[Pathological features and treatment of ulcerative lesions of the duodenum associated with Crohn's disease]

Among a total of 22 patients with Crohn's disease, eight patients with duodenal ulcerative lesions were investigated for pathological features and treatment. All duodenal ulcerative lesions of the eight patients were difficult to be distinguished morphologically from peptic duodenal ulcers at the beginning. But during the course of observation six of eight lesions revealed different pathological features from peptic duodenal ulcers: One showed highly edematous mucosa. Four granular mucosa, and another one longitudinal ulcers and cobblestone appearance. Gastric analysis of these patients showed 6.6 +/- 4.0 mEq/L of BAO and 21.3 +/- 3.4 mEq/L of MAO which was comparable to high acidity of peptic duodenal ulcers. Effectiveness of administration of anti-peptic ulcer drugs only and both anti-peptic ulcer drugs plus drugs against Crohn's disease were 40.0% and 57.1%, respectively. Two patients underwent distal partial gastrectomy. Recurrence was not observed. In conclusion, high acidity would be a cause of duodenal ulcerative lesions associated with Crohn's disease, and the pathological features of them would be affected by Crohn's disease itself. Anti-peptic ulcer drugs should to be administered as well as drugs against Crohn's disease. The method which has hypoacidity effect should be selected in operative therapy to such patients as to have stenosis of the duodenum.

The mechanism of acute gastric ulcer after induced hemorrhagic shock

Changes in gastric mucosal blood flow were investigated for their relationship to gastric mucosal prostaglandin E2 (PGE2) and noradrenaline (NA) in rats with hemorrhagic shock. The results were as follows: 1) Gastric mucosal blood flow and NA decreased after hemorrhage. Gastric mucosal PGE2 initially increased after exsanguination and then markedly decreased. 2) Administration of NA before hemorrhage resulted in an increase of PGE2. However, the PGE2 value for animals receiving NA after hemorrhage was not different from that of non-NA-treated group. 3) Pre-treatment with PGE2 suppressed the reduction in both gastric mucosal blood flow and NA and the development of ulcer. These results suggest that the increase in gastric mucosal PGE2 in the early stage of shock might represent a phenomenon of adaptation by the adrenergic activation, and the decrease in PGE2 in the late stage might result from impaired synthesis of PGE2 due to persistent hypoxia and might be one of the possible factors in ulcer formation.

In vivo activity on murine tumors of a novel antitumor compound, N-beta-dimethylaminoethyl 9-carboxy-5-hydroxy-10-methoxybenzo[a]phenazine-6-carboxamide sodium salt (NC-190)

A novel antitumor compound, N-beta-dimethyl-aminoethyl 9-carboxy-5-hydroxy-10-methoxybenzo[a]-phenazine-6-carboxamide sodium salt (NC-190) was evaluated for its antitumor activity in experimental murine tumor systems. In the initial studies with P388 leukemia (i.p.-i.p.), NC-190 led to an increase of greater than 200% in life span (ILS), and 75% of the mice were alive on day 30, when the optimal dose (50 mg/kg, days 1-5) was given. Additionally, the compound had significant activities against i.p. inoculated mouse L1210 leukemia, B16 melanoma, M5076 reticulum cell sarcoma, sarcoma 180, mouse hepatoma MH134, and rat Yoshida sarcoma and Yoshida ascites hepatoma AH130. The optimal dose resulted in a greater than 280% ILS with a 30-day survival of 50% in mice with L1210 leukemia (100 mg/kg, days 1-5), a 156% ILS in mice with B16 melanoma (50 mg/kg, days 1-5), a 98% ILS with a 90-day survival of 25% in mice with M5076 reticulum cell sarcoma (25 mg/kg, days 1, 5, 9, and 13), a greater than 300% ILS with a 60-day survival of 50% in mice with sarcoma 180 (50 mg/kg, days 3-10), a 148% ILS with a 60-day survival of 25% in mice with MH134 (25 mg/kg, days 1-5), a 129% ILS with a 60-day survival of 12.5% in rats with Yoshida sarcoma (12.5 mg/kg, day 3-10), and a greater than 161% ILS with a 60-day survival of 50% in rats with AH130 (6.3 mg/kg, days 3-10). In the experiments with s.c. inoculated tumors, NC-190 not only inhibited tumor growth, but also increased the life span of mice with Lewis lung carcinoma or B16 melanoma. The 60-day survivors accounted for 60% and 30% in mice with Lewis lung carcinoma and B16 melanoma, respectively. The compound significantly inhibited the spontaneous lung metastasis of Lewis lung carcinoma by more than 90% when eight daily i.v. injections were given. NC-190 was active by the i.p., s.c., and i.v. routes. Five consecutive daily i.p. doses (days 1-5) were more effective than a single dose (day 1), two doses (days 1 and 5), or three doses (days 1, 5, and 9). NC-190 warrants further study as a potential antineoplastic agent against human neoplasms, as it has a broad spectrum of antitumor activity and inhibits metastasis.

Clinicohistopathologic and immunohistochemical studies of intrapancreatic development of carcinoma of the head of the pancreas

Clinicohistopathologic and immunohistochemical studies of intrapancreatic development of duct cell carcinoma of the head of the pancreas to the body and tail were done in 34 cases in which total pancreatectomy accompanied by portal vein resection were performed from July 1981 to June 1987. In studies of hematoxylin and eosin (HE) staining, intrapancreatic development from the head to the body or tail was observed in 14 cases of 34 cases (41.1%). Multicentricity or skip development was observed in two of 14 cases. However, by using immunostaining of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and DUPAN2, small cancer nests surrounded by dense fibrous connective tissues could be easily and accurately diagnosed, and finally, in 25 of 34 cases (73.5%), intrapancreatic continuous development from the head to body or tail was observed. The intrapancreatic development correlated with portal invasion and perineural invasion of carcinoma, hardness of body and tail, obstruction of the main pancreatic duct, and irregular pancreaticogram. The intraoperative quick immunostaining on the cryostat sections, together with HE staining, is useful to determine the intrapancreatic development of the carcinoma. The indication of total pancreatectomy or pancreatoduodenectomy for carcinoma of the head of the pancreas can be determined by these results.